Do Hearing Aids Help Tinnitus? What the Evidence Says
Tinnitus (ringing, buzzing, or hissing in the ears) affects about 25 million American adults, and it frequently accompanies hearing loss. Hearing aids do not cure tinnitus, but many people report a reduction in how much it bothers them. The evidence is mixed, the mechanism is debated, and the cognitive benefit once claimed for hearing aids has not held up in the highest-quality trial to date.
Key takeaways
- About 25 million American adults have tinnitus (NIDCD, last updated September 20, 2024), and roughly 90% have measurable hearing loss.
- Hearing aids help some people with tinnitus, but not all. Many report the ringing is less noticeable or less bothersome while wearing aids; the mechanism is debated.
- Tinnitus in one ear only is a red-flag symptom. It requires prompt medical evaluation, not self-treatment with OTC devices.
- Do not treat hearing aids as dementia prevention. The ACHIEVE trial's primary endpoint was null (p=0.96), and a prespecified subgroup benefit does not generalize to the overall population.
- If tinnitus is new, sudden, or worsening, see a doctor first. Treatable causes (wax, infection, ototoxic medication) should be ruled out before assuming it is permanent.
Tinnitus is the perception of sound when no external sound is present. It is usually described as ringing, buzzing, hissing, humming, or clicking, and it is nearly always a symptom of something else rather than a disease itself. About 25 million American adults experience tinnitus (NIDCD Quick Statistics, last updated September 20, 2024), and the vast majority have some degree of hearing loss alongside it. Hearing aids do not cure tinnitus, but many people find that amplifying external sound makes the internal noise less noticeable or less bothersome.
What is tinnitus?
Tinnitus is sound you hear that originates inside your auditory system rather than from the environment. It can be constant or intermittent, in one ear or both, and it ranges from barely noticeable to disabling. The most common form is subjective tinnitus, which only you can hear. A much rarer form, objective tinnitus, can sometimes be heard by a clinician during an exam and usually has a physical source such as blood flow or muscle contractions near the ear.
Tinnitus is most often caused by damage to the hair cells in the inner ear, the same damage that causes sensorineural hearing loss. Other causes include earwax blockage, middle ear infection, head or neck injury, certain medications (aspirin, some antibiotics, diuretics), Meniere's disease, and temporomandibular joint (TMJ) disorders. In rare cases, tinnitus can signal a more serious condition such as an acoustic neuroma or vascular malformation, which is why new or one-sided tinnitus should be evaluated by a doctor.
For most people, tinnitus is a chronic nuisance rather than a medical emergency, but it can interfere with concentration, sleep, and quality of life. There is no FDA-approved cure, and treatment focuses on reducing the perception of tinnitus or the distress it causes.
How hearing aids may help tinnitus
Hearing aids do not eliminate tinnitus, but they can make it less intrusive. The most widely cited mechanisms are:
- Masking. Amplifying environmental sound can partially or fully mask the internal tinnitus signal, making it less noticeable.
- Auditory stimulation. Restoring input to the auditory cortex may reduce the brain's compensatory gain that is thought to generate tinnitus in the first place.
- Reduced listening effort. Straining to hear in quiet can make people more aware of tinnitus. Amplification reduces effort, which may reduce focus on the tinnitus.
- Habituation support. Some hearing aids include dedicated tinnitus sound therapy (white noise, nature sounds, or notched tones) to aid habituation, the process by which the brain learns to ignore a persistent sound.
None of these mechanisms is conclusively proven, and the effect varies widely. Some people report immediate relief; others notice no change. The benefit often depends on whether the hearing loss and tinnitus occupy the same frequency range, and on how much the tinnitus is driven by auditory deprivation versus other factors.
What the evidence says
The evidence for hearing aids as a tinnitus treatment is positive but mixed. A 2018 Cochrane review found insufficient high-quality evidence to determine whether hearing aids reduce tinnitus severity, though the review noted that many observational studies and surveys report benefit. Clinical experience and patient surveys consistently find that a majority of people with both hearing loss and tinnitus report some improvement when wearing hearing aids, but controlled trials are scarce and often small.
The American Academy of Audiology's 2023 clinical practice guideline on tinnitus recommends hearing aids as a treatment option for patients with both hearing loss and bothersome tinnitus, with the caveat that benefit is not universal. The guideline also notes that counseling and sound therapy (including the sound generators built into many hearing aids) are effective for many patients.
In short: hearing aids help many people with tinnitus, but they are not a guaranteed solution, and they work best when hearing loss is present and when the aids restore audibility in the frequency range where tinnitus is perceived.
Do hearing aids prevent dementia?
No. Observational research has consistently found that untreated hearing loss is associated with higher rates of cognitive decline and dementia, and hearing loss has been identified as a modifiable risk factor in several major reports, including the Lancet Commission on Dementia Prevention. However, association is not causation, and the first large randomized trial to test the question found no overall benefit.
The ACHIEVE study (Aging and Cognitive Health Evaluation in Elders, Lin et al., The Lancet 2023, trial registration NCT03243422) enrolled 977 adults aged 70 to 84 with untreated hearing loss. Participants were randomized to hearing intervention (audiologist-fitted hearing aids plus support) or a health education control. The primary endpoint was 3-year change in a global cognitive composite score, combining data from two cohorts: the ARIC (Atherosclerosis Risk in Communities) study and a healthier de novo cohort.
The primary endpoint showed no significant difference between groups (difference 0.002 standard deviations, p=0.96). In a prespecified subgroup analysis, the ARIC cohort (n=238, older and at higher cardiovascular risk) showed a 48% reduction in cognitive decline over three years with hearing intervention. The de novo cohort (n=739, healthier volunteers) showed no effect.
The ACHIEVE trial is the highest-quality evidence to date, and its primary endpoint was null. The subgroup finding is hypothesis-generating but does not support a general recommendation to treat hearing aids as dementia prevention. Proposed mechanisms for the association between hearing loss and dementia include increased cognitive load from effortful listening, social isolation, and structural brain changes from reduced auditory input, but whether treating hearing loss interrupts those pathways remains uncertain.
If you are considering hearing aids because you have hearing loss and it interferes with your life, that is a sufficient reason on its own. Do not expect cognitive protection as a primary benefit based on current evidence.
Source: Lin FR, Pike JR, Albert MS, et al. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. The Lancet. 2023;402(10404):786-797. PMC10529382. See also achievestudy.org for trial details.
When not to self-treat tinnitus
Do not use over-the-counter hearing aids for tinnitus without first seeing a doctor if any of the following apply:
- Tinnitus in one ear only. Unilateral tinnitus is a red-flag symptom that can indicate an acoustic neuroma, vascular abnormality, or other condition requiring imaging and specialist evaluation. See the red-flag symptoms in our hearing loss signs guide.
- Sudden onset. Tinnitus that started within the past 90 days, especially if accompanied by sudden hearing loss, requires prompt medical evaluation (ideally within days).
- Pulsatile tinnitus. Tinnitus that sounds like a heartbeat or whooshing in sync with your pulse can indicate a vascular cause and requires imaging.
- Accompanied by dizziness, vertigo, or balance problems. These symptoms together can signal Meniere's disease, vestibular schwannoma, or other inner ear pathology.
- Accompanied by pain, drainage, or fullness in the ear. These suggest infection, impacted wax, or middle ear fluid, all of which are treatable and should not be masked with amplification.
The FDA's over-the-counter hearing aid rule allows adults 18 and older with perceived mild to moderate hearing loss to buy devices without a prescription, but the rule also lists red-flag conditions that require medical clearance first. Unilateral symptoms are high on that list. For more on when OTC is appropriate and when it is not, see our OTC vs. prescription comparison.
What to do next
If you have both hearing loss and tinnitus, the first step is a hearing test and a medical evaluation to rule out treatable causes. An audiologist can measure your hearing loss, assess your tinnitus pitch and loudness (if needed), and recommend whether hearing aids are a reasonable option.
If hearing aids are recommended, many modern devices include tinnitus sound therapy features (also called sound generators or maskers) that can supplement the benefit of amplification. Brands with dedicated tinnitus programs include Widex (Zen therapy), Signia (Notch Therapy and static noise), Starkey (Multiflex Tinnitus Technology), and Phonak (Tinnitus Balance). The sound therapy is typically optional and can be turned off if you do not find it helpful.
Other evidence-based tinnitus treatments include cognitive behavioral therapy (CBT), which addresses the distress caused by tinnitus, and sound therapy outside of hearing aids (white noise machines, apps, or bedside sound generators). Avoid unproven treatments such as dietary supplements marketed for tinnitus, which are not FDA-regulated and have not been shown to work in rigorous trials.
For a broader overview of when hearing aids are appropriate and how to choose them, see our hearing aid decision guide.
Sources
- NIDCD Quick Statistics About Hearing (last updated September 20, 2024): approximately 25 million American adults have experienced tinnitus lasting at least five minutes in the past year.
- Lin FR, Pike JR, Albert MS, et al. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. The Lancet. 2023;402(10404):786-797. PMC10529382.
- ACHIEVE Study (Aging and Cognitive Health Evaluation in Elders): trial registration NCT03243422, study design, and public materials.
- Hoare DJ, Edmondson-Jones M, Sereda M, Akeroyd MA, Hall D. Amplification with hearing aids for patients with tinnitus and co-existing hearing loss. Cochrane Database Syst Rev. 2014;(1):CD010151. Updated 2018.
- American Academy of Audiology. Clinical Practice Guideline: Tinnitus. 2023.
- FDA Over-the-Counter Hearing Aids: final rule effective October 17, 2022 (87 FR 50698), conditions of use, and red-flag symptoms requiring medical evaluation.